Provider Demographics
NPI:1225013758
Name:WILLEFORD, GEORGE III (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:WILLEFORD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-485-5878
Mailing Address - Fax:512-420-0397
Practice Address - Street 1:1111 W 34TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1900
Practice Address - Country:US
Practice Address - Phone:512-454-4588
Practice Address - Fax:512-459-9869
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4764207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23501Medicare UPIN
TX8312M8Medicare PIN